As for the concern that the fever and body temperature might rise too high, you can be reassured by knowing that a fever can not go beyond a certain plateau phase. In previous centuries this fact was not understood, and when people died from meningitis, for example, it was claimed they had died of a fever. That is also why there are rhymes warning against fever and ending in predictions of death!
You cannot die of a fever, but you may possibly die of an illness underlying the fever, such as meningitis or malaria. Any serious underlying illness like meningitis, malaria or pneumonia needs to be excluded, of course.
rhyme still scares people:
the fever’s begun,
you're feeling quite blue,
you get wobbly at the knee,
you are at death's door,
you're more dead than alive,
you are crossing the Styx,
you are an angel in heaven!
these are old tales.
A test to exclude meningitis is to sit the child upright with his or her legs stretched out on the bed, and ask the child to look at their belly button (or keep a toy there to try and make the child look down without forcing). In meningitis this is likely to cause distress because this stretches the meninges. These are the sheath of the brain, enveloping the brain from the forehead, over the top of the head and down the spinal cord, right down to the tailbone.
When this sheath of the brain is inflamed, (i.e. in meningitis), this ‘neck-down’ position can cause a pain in the head and/or neck. (Mind you, flu will cause a pain in the neck area when the person looks down but this pain comes from the neck muscles rather than from the meninges.) A headache, lethargy, and being irritated by light can be indicators of meningitis.
Sometimes these meningitis bacteria
circulate in the bloodstream and do not cause a pain in the neck or headache, this is called septiacaemia. In a typical case, this infection can show up as small bruises. So you need to look for a rash as well — it usually looks
like little bruises which do not fade when the spots are pressed. Meningitis and septicemia can develop in a matter of hours.
Management of fever
When a serious underlying illness
is excluded, you can help the child with tender loving care.
During a fever the body wants to heat itself up completely, that
is, right up to the hands and feet. Therefore, what you need to
do is to check whether the hands and feet are warm. When these
are still cold, then it is best to keep the child warm. Once the
hands and feet are warm, you can take off the blanket or warm
clothes. Just imagine yourself when you have a flu-like illness.
At first you tuck yourself under the covers because you are
feeling cold. Actually, the body temperature is rising when you
feel cold and shivery. Once you are hot all over you get
bothered, and throw away the blankets to make yourself
comfortable. Don't strip the child off completely or have them
shiver from the cold and have goose pimples. Sponging the body
might seem kind and loving, but it is uncomfortable for a
Some children are prone to febrile
hallucinations. This is always very distressing for the child,
and also for the parent. Afterwards the child has little
recollection but the parents remember everything! Try and stay
calm yourself. It helps to cool the child, to take him or her
out of bed. Usually the episode recedes in a matter of minutes.
Overall it is not about
‘controlling’ the temperature or ‘managing’ the temperature but
about supporting the fever process. You will notice that running
a temperature is like running a distance. The child will breathe
faster and the heart rate is up and the child will be listless.
But once the body has managed to heat itself up into the hands
and into the feet, the child will start to perk up again.
Therefore it is important to support the fever process and help
the body to heat itself into the hands and feet. You would do
the same for yourself when you feel cold and shivery despite
already having a high fever, you would keep yourself under the
duvet until the body has managed to warm up the hands and feet
as well. If carers start to try and get the temperature down,
then the body has to put extra effort in and this will exhaust
and distress the child. Therefore it is about supporting the
fever process in order that the body doesn’t need to put ever
more effort in to heat every part of the body.
Paracetamol (acetaminophen) are
analgesics (painkillers) and can be given if the child has pain
or muscle ache or is you think it is distressed by the fever,
but often the temperature will go up again anyway and that is
due to the above described fever process. The fever is a healing
mechanism and you do not need to worry that ‘the temperature can
get too high’ – is has never been in the newspapers that again
another child has boiled – and febrile convulsions, in general,
only happen when there is a sudden rise in temperature, in other
words, usually a convulsion comes out of the blue and not when
the fever is noticed.
Expect the child to perk up a few
times over 24 hours, and often it is noticed that the
temperature goes up at night time, this fits with bio-rhythms
(circadian rhythms). However, if the child is constantly
lethargic then it needs to be seen by a doctor because in that
case it might have a serious bacterial infection or Kawasaki
A feverish child will not have any
appetite and eat poorly, which is perfectly all right for a few
days. Fluids should be offered, of course, to prevent
dehydration. Clear liquids like fruit juice or squash (but no
fizzy drinks) are best. Actually, often the child seems
basically content despite a raging temperature, but it is the
parents who are worried!
It is impressive to realise that we
constantly maintain a body temperature of 37 degrees Celsius,
but even more impressive that we can produce the great heat of a
fever. Fever is largely a childhood condition. Children seem to
have the ability to produce fevers easily and can tolerate them
better than adults. (High fevers are less common in adults and
are more often a symptom of a serious illness.) Fevers should be
viewed with reverence, particularly when we consider that this
heat originates from the Sun! As discussed in a previous chapter
, plants bind the warmth of the Sun into their substance. When
humans absorb food, this warmth is released into our bodies when
it is broken down by oxygen, like the heat from a burning log
fire. The following can give a sense of reverence for fever.
The body of the newly born baby is
completely built up from substances delivered through the
mother. From the moment of birth, with the first breath of
oxygen, the baby will start to break down and reorganise these
motherly substances. Through the breathing process and feeding,
the baby starts to rearrange and transform his or her little
body to correspond to its own individuality. During a fever, a
dramatic transformation is taking place in the body. The body
might need the fever in order to leap hurdles in this process of
maturing. We could say that, on the one hand we come into the
world with inherited substances and forces, linking us with our
past; but on the other hand we go through a process of personal
development, drawing us into the future.
To summarize: Fever is alright as
long as you remain vigilant for a dangerous underlying
infection. Children younger than 6 months with a fever need to
see a doctor. The advice is to keep checking every few hours for a
rash than does not fade when pressed as in septicaemia (when the
bacteria circulate in the blood). Usually people only lift up
the tummy shirt but you need to check every part of the body!
Secondly check at the same time for meningitis (when the
bacteria have infected the sheaths of the brain). See the
drawings and text above. If the temperature is above 39C, try
and catch a urine sample which the doctor can check for
infection. The National Institute for Clinical Excellence - NICE
- has also written information for parents, the link for this
you can find in the references below.
As such we do better by supporting
the fever process so that a new beneficial balance can develop.